Our project proposes to implement teamwork training based on naval research on high performance teams under stress (Cannon-Bowers and Salas, 1998; Salas, 2001). Our teamwork training curriculum will use high fidelity simulations of critical clinical events to train all multidisciplinary resuscitation teams (Rapid Response Teams and Code Blue Teams) in a tertiary care hospital that serves a large rural patient population. Our ultimate aim is to decrease mortality rates in non-expectant (non-Do Not Resuscitate), non-intensive care unit patients in an acute care, inpatient facility. By improving team coordination processes and teamwork knowledge, skills, and attitudes in resuscitation teams, we believe that we will decrease mortality rates in non-expectant adult inpatients in Non-Intensive Care Unit settings, decrease the number of Code Blue alerts, and decrease the time to initiate appropriate treatments in code and rapid response teams and, ultimately, change the institutional culture of patient safety. This project will evaluate the impact of our theory-based team training simulations on individual, team, and institutional processes and outcomes related to patient safety. As this is a research project measuring the impact of team training interventions on real patient outcomes and real workplace scenarios, our research design will be a prospective cohort pre-post design. Our metrics for success are based on the patient safety culture and high performance team training research of Cannon-Bowers and Salas, Helmreich, and Sexton. We plan to compare baseline observational, self-report, and patient outcomes data (Phase One) with identical data that we will collect (Phase Three) after implementing simulation-based team training based on Serfaty's team training model and Baker et al's (2003) recommendations for team training in medicine (Phase Two). We plan to translate research developed for the training of high performance naval teams working under intense stress to the medical environments of multidisciplinary Rapid Response Teams and Code Blue Teams in hospitals. We believe that team coordination training using high fidelity simulators and reflective videotaped debriefings will help patient safety by improving medical team communication and coordination of efforts during life-threatening situations, by changing hospital culture to be more attuned to patient safety, and, ultimately, by decreasing the rate of unexpected deaths in non-intensive care settings. Our findings with RRTs will have public health implications because of the relevance to rural and small community hospitals that serve many rural and underserved Americans. Because many of these hospitals do not have 24 hour, 7 day a week in-hospital medical staff coverage to respond to immediate crisis management events, training multidisciplinary RRT teams in team communication and coordination will be all the more crucial to saving lives. [unreadable] [unreadable] [unreadable]